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Correlation of Pediatric Surgical Infrastructure With Clinical and Economic Outcomes: A Cohort Study
Samuel Negash1, Ava Yap2, Caroline Q Stephens2
1Department of Surgery, Menelik Hospital, Addis Ababa, Ethiopia.
Insights
Installing a pediatric operating room in Ethiopia significantly increased surgical access and averted thousands of disability-adjusted life years (DALYs) for children. This investment demonstrates substantial economic benefits, improving health equity for impoverished families.
Area of Science:
- Global Health
- Pediatric Surgery
- Health Economics
Background:
- Significant unmet need for pediatric surgical care in low- and middle-income countries.
- Ethiopia faces a substantial burden of pediatric surgical disease.
- Limited access to specialized surgical services for children.
Purpose of the Study:
- To assess the impact of a pediatric operating room (OR) installation on clinical and economic outcomes for children in Ethiopia.
- To evaluate the association between enhanced surgical infrastructure and patient benefits.
- To determine the economic value of pediatric surgical interventions.
Main Methods:
- Retrospective cohort study comparing outcomes before and after pediatric OR installation in August 2019.
- Analysis of clinical data (n=1196) and caregiver economic surveys (n=339).
- Interrupted time series analysis for surgical volume trends and value of statistical life method for economic benefit assessment.
Main Results:
- Pediatric OR installation led to a significant increase in monthly case volume and averted 20,541 disability-adjusted life years (DALYs).
- Median household income was $1337, with 27.7% in extreme poverty and 41.3% facing catastrophic healthcare expenditure.
- Net monetary health benefit reached $29.3 million ($26,646 per patient), a 60:1 ratio to household income.
Conclusions:
- Installation of a pediatric OR in Ethiopia improves access to essential surgery for impoverished populations.
- The findings highlight the role of pediatric surgical infrastructure in promoting equitable access to care.
- Increased investment in pediatric surgical facilities is crucial for addressing global child health inequities.
Introduction:
A significant burden of unmet pediatric surgical disease exists in low- and middle-income countries. We sought to assess the associations between the installation of a pediatric operating room (OR) and clinical and economic outcomes for families with children in Ethiopia.
Methods:
A retrospective cohort study was performed of children who underwent elective surgery in a tertiary-level Ethiopian public hospital, comparing patient outcomes before and after OR installation in August 2019. Clinical data were collected via chart review, and an inpatient economic survey was administered to patient caregivers. Interrupted time series analysis investigated trends in surgical volume over time. The relative economic benefit was determined by comparing the patients' household income to the monetary health benefit gained using the value of statistical life method.
Results:
One thousand one hundred and ninety-six patients were included from August 2018 to July 2022. Surgery averted 20,541 disability-adjusted life years (DALYs) cumulatively or 17 DALYs per patient. Monthly case volume and DALYs averted significantly increased postinstallation. The median annual household income of the economic survey responders (n = 339) was $1337 (IQR 669-2592). 27.7% (n = 94/339) lived in extreme poverty, and 41.3% (n = 140/339) experienced catastrophic healthcare expenditure. Net monetary health benefit was $29.3 million or $26,646 per patient. The ratio of net monetary health benefit to household annual income was 60:1.
Conclusions:
Installing a pediatric OR in a public Ethiopian hospital ensures increased access to surgery for those most impoverished in Ethiopia and improves equitable access to surgical care. Greater investment in expanding pediatric surgical infrastructure can help address global inequities in child health.
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